Antiplatelet and Anticoagulant Drugs Flashcards
1
Q
aspirin drug name
A
- acetyl-salicylic acid (ASA)
2
Q
aspirin at low doses MOA
A
- irreversibly acetylates COX1
- inhibits generation of TXA2
3
Q
higher doses of aspirin MOA
A
- inhibit COX2
4
Q
aspirin used for
A
- primary and secondary prevention of arterial blockages
5
Q
examples of arterial blockages
A
- MI
- stroke
- PVD
6
Q
aspirin side effects
A
- GI bleeding
- provoke asthma
- kidney damage
7
Q
aspirin contraindicated in which population
A
- children and teenagers with chickenpox or flu symptoms
8
Q
GI bleeding of aspirin
A
- inflammation
- peptic ulcer disease
9
Q
at high doses aspirin can cause
A
- salicylate toxicity
- tinnitus
10
Q
warfarin biochemical effect
A
- vitamin K antagonist
11
Q
warfarin MOA
A
- blocks reduction of Vit K
- limits carboxylation of coagulation factors
12
Q
what stage of vitamin K does warfarin block?
A
- NEW VITAMIN K
13
Q
time of effect of warfarin
A
- not immediate
14
Q
first three days of warfarin
A
- brings to hyper coagulable state
15
Q
how to reverse warfarin hyper coagulable state
A
- bridging anticoagulant therapies
16
Q
hyper coagulable state worse in patients with
A
- protein C deficiency
- vitamin K deficiency
17
Q
warfarin used for treatment of
A
- VTE
18
Q
warfarin used for prevention of
A
- thrombosis on mechanical heart valves
- embolic strokes in patient with Afib
19
Q
how do we measure warfarin dosing
A
- measure INR weekly to start
20
Q
what do we want the IR to be for warfarin
A
- between 2-3
21
Q
drug food interactions of warfarin
A
- maintain steady amount of vitamin K containing foods
22
Q
drug-drug interactions of warfarin
A
- drugs that interfere with CYP enzymes
- antibiotics
23
Q
monitoring warfarin at therapeutic levels
A
- follow PT/INR
24
Q
warfarin at toxic levels has what effect on the aPTT
A
- prolonged
25
warfarin effect on PFA-100
- no effect
26
side effects of warfarin
- alopecia
- osteoporoesis
- bleeding
- warfarin skin necrosis
27
how does someone get warfarin skin necrosis?
- vitamin K deficient
| - protein C deficiency without bridging
28
warfarin skin necrosis effects the
- microvascular thrombosis
| - fatty tissues
29
warfarin and pregnancy
- warfarin is a teratogen
30
warfarin and lactating women
- okay for lactating women
31
warfarin reversal
- vitamin K
| - prothrombin complex concentrates (PCC)
32
PCC composed of
- factor 2, 7, 9, 10
33
composition of animal derived heparin
- polysaccharide with variable sulfated residues
34
variation in polysaccharide sequence and length and degree of sulfation in heparin make it
- heterogenous
| - each dose different and impacts each individual differently
35
heparin binds
- antithrombin
36
heparin inactivates
- factor Xa, IXa, XIa
37
full length heparin forms a complex with
- thrombin and antithrombin
38
how long does heparin have to be to inactivate thrombin
- 18 sugars long
39
unfractionated heparin must be given in which form
- IV
| - SQ
40
unfractionated heparin must be given in which setting
- the hospital
41
what do you follow in heparin monitoring?
- aPTT
| - anti-Xa level
42
heparin effect on TCT
- prolonged TCT
43
heparin effect on PT
- normal as long as it is not a large dose
44
how is the Xa level measured with heparin
- rate of conversation of a substrate into a colored byproduct
- add patient's plasma to mix and see if it slows the conversion to a colored solution
- decrease in rate is the Anti-Xa level
45
heparin side effects
- bleeding
- osteoporosis with long term use
- hyperkalemia
- development of heparin induced thrombocytopenia
46
heparin antidote
- protamine sulfate
47
protamine sulfate MOA
- positively charged
| - neutralizes negatively charged heparin
48
low molecular weight heparin compared to unfractionated heparin
- smaller
| - about 1/3 the size
49
drug name of LMWH
- enoXaparin
50
enoxaparin given via
- SQ
51
bioavailability of enoxaparin
- immediately bioavailable
52
enoxaparin can be used to
- bridge warfarin
53
enoXaparin MOA
- inactivates Xa
54
why can enoXaparin not inactivate thrombin
- it is too short
55
LMWH effect on PT
- no effect
56
LMWH effect on aPTT
- no effect
57
what do you follow with patients on LMWH
- Anti-Xa levels
58
antidote for LMWH
- no antidote
59
LMWH uses
- VTE treatment and prophylaxis
| - VTE associated with cancer
60
treatment of LMWH for VTE
- done at home via SQ
| - especially pregnant women
61
LMWH side effects
- bleeding
- pain at injection site
- can't use in dialysis
- HIT
62
if HIT, what happens with LMWH
- can't use
63
Fondaparinux complex
- pentasaccharide part of heparin
| - don't use in kidney failure
64
Fondaparinux mechanism
- bind to antithrombin
| - inactivate Xa
65
Fondaparinux and HIT
- does not cause HIT
| - may worsen HIT
66
Fondaparinux route of administration
- SQ
67
Fondaparinux antidote
- no antidote
68
DOACs
- direct oral anti coagulants
69
Dabigatran MOA
- inactivates thrombin directly
70
Dabigatran used for
- prevention of stroke in Afib patients
| - treatment of VTE
71
Dabigatran not used for
- heart valves
72
Dabigatran effect on TT
- prolongs TT because it inactivates thrombin
73
Dabigatran adverse effects
- bleeding
- GI upset
- renal clearance
74
Dabigatran mechanism of entry
- oral
75
Dabigatran antidote
- Idarucizumab
| - Prax-bind
76
Argatroban mechanism of entry
- IV
77
Argatroban MOA
- direct thrombin inhibitor
78
Argatroban used for patients with
- HIT
79
Argatroban metabolized how
- hepatically
80
Argatroban effect on aPTT
- prolongs
81
Argatroban effect on PT/INR
- prolongs
82
Argatroban effect on TCT
- prolongs
83
Argatroban how to monitor
- use aPTT
84
RivaroXaban, ApiXaban, and EdoXaban MOA
- inactivates Xa
- binds Xa inhibitor competitively with Xa
- GLA domain removed to prevent anticoagulant effect
85
RivaroXaban, ApiXaban, and EdoXaban cleared by
- kidney
| - chemical degradation
86
DOACs advantages over warfarin
- fewer intracranial bleeds
87
DOACs disadvantages compared to warfarin
- not effects in preventing stroke in patients with mechanical heart valves
